Oxygen Saturation and Perfusion Index-Based Enhanced Critical Congenital Heart Disease ScreeningFunding The authors would like to thank Department of Pediatrics at University of California, Davis for financially supporting this project.
22 January 2019
07 March 2019
19 April 2019 (online)
Objective To determine if addition of perfusion index (PIx) to oxygen saturation (SpO2) screening improves detection of critical congenital heart disease (CCHD) with systemic outflow obstruction.
Study Design We determined screening thresholds for PIx and applied these to a cohort of newborns with and without congenital heart disease (CHD).
Results A total of 123 normal and 21 CHD newborns (including five with critical systemic outflow obstruction) were enrolled. Four of these five critical systemic obstruction subjects passed SpO2-based screen. Four out of these five subjects failed PIx-based screen. The sensitivity for detection of systemic obstruction CCHD when compared with healthy infants increased from 20% (95% confidence interval [CI]: 1–72%) with SpO2 screening alone to 80% (95% CI: 28–100%) with combined SpO2-PIx screen. However, 2.44% of normal infants failed PIx screen.
Conclusion Addition of PIx to SpO2 screening may detect additional cases of CCHD and further research is necessary to come up with optimal screening thresholds.
- 1 Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr 2008; 153 (06) 807-813
- 2 Oster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M, Correa A. Temporal trends in survival among infants with critical congenital heart defects. Pediatrics 2013; 131 (05) e1502-e1508
- 3 Wren C, Reinhardt Z, Khawaja K. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Arch Dis Child Fetal Neonatal Ed 2008; 93 (01) F33-F35
- 4 Koppel RI, Druschel CM, Carter T. , et al. Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns. Pediatrics 2003; 111 (03) 451-455
- 5 Abu-Harb M, Hey E, Wren C. Death in infancy from unrecognised congenital heart disease. Arch Dis Child 1994; 71 (01) 3-7
- 6 Gilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation 2010; 122 (22) 2254-2263
- 7 Hunter S, Heads A, Wyllie J, Robson S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric ultrasonographers. Heart 2000; 84 (03) 294-298
- 8 Randall P, Brealey S, Hahn S, Khan KS, Parsons JM. Accuracy of fetal echocardiography in the routine detection of congenital heart disease among unselected and low risk populations: a systematic review. BJOG 2005; 112 (01) 24-30
- 9 Westin M, Saltvedt S, Bergman G. , et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36,299 fetuses. BJOG 2006; 113 (06) 675-682
- 10 Quartermain MD, Pasquali SK, Hill KD. , et al. Variation in prenatal diagnosis of congenital heart disease in infants. Pediatrics 2015; 136 (02) e378-e385
- 11 Manja V, Mathew B, Carrion V, Lakshminrusimha S. Critical congenital heart disease screening by pulse oximetry in a neonatal intensive care unit. J Perinatol 2015; 35 (01) 67-71
- 12 Mahle WT, Newburger JW, Matherne GP. , et al; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, and Interdisciplinary Council on Quality of Care and Outcomes Research; American Academy of Pediatrics Section on Cardiology And Cardiac Surgery; Committee On Fetus And Newborn. Role of pulse oximetry in examining newborns for congenital heart disease: a scientific statement from the AHA and AAP. Pediatrics 2009; 124 (02) 823-836
- 13 de-Wahl Granelli A, Wennergren M, Sandberg K. , et al. Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns. BMJ 2009; 338: a3037
- 14 Secretary of Health & Human Services Letter to the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC); September 21, 2011 . Available at: https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/heritable-disorders/reports-recommendations/response-congenital-cyanotic.pdf . Accessed March 20, 2019
- 15 Ailes EC, Gilboa SM, Honein MA, Oster ME. Estimated number of infants detected and missed by critical congenital heart defect screening. Pediatrics 2015; 135 (06) 1000-1008
- 16 Abouk R, Grosse SD, Ailes EC, Oster ME. Association of US state implementation of newborn screening policies for critical congenital heart disease with early infant cardiac deaths. JAMA 2017; 318 (21) 2111-2118
- 17 Lannering K, Bartos M, Mellander M. Late diagnosis of coarctation despite prenatal ultrasound and postnatal pulse oximetry. Pediatrics 2015; 136 (02) e406-e412
- 18 Patankar N, Fernandes N, Kumar K, Manja V, Lakshminrusimha S. Does measurement of four-limb blood pressures at birth improve detection of aortic arch anomalies?. J Perinatol 2016; 36 (05) 376-380
- 19 Palmeri L, Gradwohl G, Nitzan M. , et al. Photoplethysmographic waveform characteristics of newborns with coarctation of the aorta. J Perinatol 2017; 37 (01) 77-80
- 20 Amirtharaj CR, Palmeri LC, Gradwohl G. , et al. Photoplethysmographic assessment of pulse transit time correlates with echocardiographic measurement of stroke volume in preterm infants with patent ductus arteriosus. J Perinatol 2018; 38 (09) 1220-1226
- 21 de-Wahl Granelli A, Ostman-Smith I. Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction. Acta Paediatr 2007; 96 (10) 1455-1459
- 22 Schena F, Picciolli I, Agosti M. , et al; Neonatal Cardiology Study Group of the Italian Society of Neonatology. Perfusion index and pulse oximetry screening for congenital heart defects. J Pediatr 2017; 183: 74.e1-79.e1
- 23 Searle J, Thakkar DD, Banerjee J. Does pulsatility index add value to newborn pulse oximetry screening for critical congenital heart disease?. Arch Dis Child 2018; 0: 1-3
- 24 Kemper AR, Mahle WT, Martin GR. , et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011; 128 (05) e1259-e1267
- 25 Jegatheesan P, Nudelman M, Goel K, Song D, Govindaswami B. Perfusion index in healthy newborns during critical congenital heart disease screening at 24 hours: retrospective observational study from the USA. BMJ Open 2017; 7 (12) e017580
- 26 Uygur O, Koroglu OA, Levent E. , et al. The value of peripheral perfusion index measurements for early detection of critical cardiac defects. Pediatr Neonatol 2019; 60 (01) 68-73